[Incorporation monitoring of employees of a radioiodine therapy ward. Is incorporation monitoring required for routine?]. / Überwachung der Mitarbeiter einer Radioiodtherapiestation mittels Ausscheidungsmessungen. Ist im Routinebetrieb eine Inkorporationsüberwachung erforderlich?

UNLABELLED: Aim of the study was to determine the annual incorporation of staff on a radioiodine therapy ward and the resulting annual effective dose (aed). Following the German incorporation guideline (gig), incorporation monitoring is not necessary for potential aed below 0.5 mSv/a. For aed > 0.5 mSv/a adherence to the 1 mSv dose limit must be verified. For doses > 1 mSv/a incorporation has to be monitored by the authority. Furthermore, the (131)I incorporation factor from the gig should be verified. METHODS: To determine the actual work related incorporation, the (131)I activity concentration in urine samples (collection over 24 h) of 14 employees of different professions were examined over a period of 27 months. RESULTS: Measured activity concentrations were related to the individual time of exposure. A constant activity supply for at least three days was assumed. The mean annual effective doses were 2.4 · 10⁻¹ mSv/a (nursing staff; n = 3), 5.6 · 10⁻² mSv/a (cleaning staff; n = 2), 2.8 · 10⁻³ mSv/a (technical staff; n = 2) and 5.2 · 10⁻³ mSv/a (physicians; n = 7). All aed were below the dose limits of the gig. The calculated mean incorporation factors ranged from 3.0 · 10⁻8 for the nursing staff to 3.6 · 10⁻¹° for the technical staff (cleaning staff: 7 · 10⁻9; physicians: 6.5 · 10⁻¹°) and were therefore well below the (131)I incorporation factor defined by the gig. CONCLUSIONS: To estimate the aed caused by incorporation of (131)I it has to be subdivided for the different requirements in the diverse fields of activity of the employees. Regarding those who spend most of their time nearby the patient an incorporation monitoring by the authority might be required. The (131)I incorporation factor from the guideline (10⁻6) can be reduced by a factor of 10. For (99m)Tc and (18)F an incorporation factor of 10⁻7 is accepted.

Normal compartment pressures of the lower leg in children.

Compartment pressures have not previously been studied in healthy children. We compared the pressures in the four lower leg compartments of healthy children with those of healthy adults. We included patients aged between two months and six years, and measured the pressures in 80 compartments of 20 healthy children using simple needle manometry. Measurements were repeated in a control group of 20 healthy adults. The mean compartment pressure in the lower leg in children was significantly higher than in adults (p < 0.001). On average, pressures in the four compartments varied between 13.3 mmHg and 16.6 mmHg in the children and between 5.2 mmHg and 9.7 mmHg in the adults. The latter is in accordance with those recorded in the literature. The mean arterial pressure did not relate to age or to pressure in the compartment. The findings of this study that the normal compartment pressure of the lower leg in healthy children is significantly higher than that in adults may be of considerable significance in clinical decision-making in children of this age.

Open mesh plug hernioplasty in ambulatory surgery: a study of feasibility based on our experience in 413 procedures.

This study assessed the feasibility, safety, and reliability of open mesh plug hernioplasty under local anesthesia on an ambulatory basis. We retrospectively evaluated results using the open mesh plug technique in a series of 398 patients with 413 inguinal hernias (378 primary, 35 recurrent). Local anesthesia with sedation was used in 91% of procedures, locoregional anesthesia in 8%, and general anesthesia in 1%. Median operative time was 45 min. Only 1% of patients operated on in ambulatory surgery required hospitalization. There were only mild complications, all of which were managed on an outpatient basis. Median time of return to work was 8 days. Recurrence rate was 0.83% at a minimal follow-up of 12 months. Open mesh plug hernioplasty is a reliable technique feasible in an outpatient basis.

The technical approach in banding to avoid pouch dilatation.

BACKGROUND: Adjustable gastric banding results in good weight loss. Nevertheless, some complications may occur, including slipping of the stomach through the band with pouch dilatation. Initially, the Belachew and Cadière technique was done with the Lap-Band. Afterwards, to minimize proximal gastric pouch dilatation (GPD), we performed the operation using the Swedish route with the same band (Inamed). METHODS: In a retrospective study, 139 consecutive adjustable gastric bands were placed laparoscopically between December 1994 and March 2000. Mean age was 37 years. 10.3% were male. Mean BMI was 39.7. Until April 1999 (Group I, n = 104), the band was introduced according to Belachew's and Cadière's technique (intragastric balloon calibration technique). Starting May 1999 (Group II, n = 35), the Lap-band was introduced using the Swedish route. This technique consists of localizing the right and left crus posteriorly. A tunnel is created behind the cardia and right above the crus after transsection of the gastrophrenic ligament. The Lap-band is introduced as well as an anterior intragastric calibrating balloon with an air chamber at its distal end, making a pouch 5 to 10 cc. RESULTS: In group I, 15.4% had GPD needing re-hospitalization. Of these, 75% required a re-operation. In group II, no slipping nor pouch dilatation has been reported so far. CONCLUSION: The Swedish route appears to be the key to avoiding GPD. By introducing an intragastric calibrating balloon with a pouch of 5 to 10 cc anteriorly, the band is placed just below the cardia, and no pouch dilatation has been found. The important factor may not be the type of band but rather the technical approach.

Transcallosal removal of lesions affecting the third ventricle: an anatomic and clinical study.

A series of 54 patients with lesions affecting the third ventricle with a wide range of pathology were operated on by the transcallosal approach. Hydrocephalus was present in 68.5% of all patients, and preoperative shunting was performed in 73.0% of them. Before the partial callosotomy, 16 patients were studied by the use of a cognitive, affective, and behavioral battery, which was repeated 10 and 100 days after the operation. No physiological consequences were ever observed after the partial commissurotomy. The postoperative callosal defect was verified by magnetic resonance imaging. Furthermore, 40 formalin-fixed brains were sectioned to study the variations of the anterior cerebral arteries. On the other hand, magnetic resonance imaging measurements of the corpus callosum in 40 normal subjects were performed to establish a classification system for the corpus callosal area. The results showed a wide variability of the cross-sectional area of the corpus callosum. The differences in the thickness of the truncus were responsible for this variability; the length of the corpus callosum was uniform. This may suggest that subjects with a large corpus callosum may have more interhemispheric connections with higher specialization of each hemisphere and that a smaller number of callosal connections may correlate with more ipsilateral pathways and more independent hemispheres. The results and the clinical as well as anatomical material indicate that the anterior transcallosal route is a safe and feasible alternative in the management of a wide spectrum of pathological lesions within the third ventricle and deserves preference over the transcortical technique.

[The surgical approach to the cochlear nucleus area]. / Der chirurgische Zugang zum Kochlearis-Kerngebiet.

The stimulation of the proximal auditory nerve or the Cochlear Nuclear Complex (CNC) situated in the lateral recess of the fourth ventricle is a possibility of hearing rehabilitation for patients suffering from bilateral deafness by bilateral cerebellopontine-angle tumors or by transsections of cochlear nerves on both sides. Using such anatomical landmarks as proximal cochlear nerve, flocculus, choroid plexus and taenia the surgeon can locate exactly the CNC for this stimulation. We investigated location, diameter and surrounding structures of the CNC on 10 human brains fixed in 10% formalin-solution and on 9 histological series of these subjects.

[Surgical anatomy of the petrous canal and posterior cranial fossa in relation to hearing preservation in surgery of acoustic neuroma]. / Chirurgische Anatomie der Pars petrosa und der Fossa cranii posterior unter dem Aspekt der Hörerhaltung bei der Operation von Akustikusneurinomen.

The suboccipital (retrosigmoid) and the middle fossa routes are recommended for preservation of hearing in surgery for acoustic neuroma. We carried out a comparative study of the critical distances and bony landmarks on 520 petrous bones. Unlike the transtemporal route, the suboccipital approach offers no landmarks for identification of the common crus, the vestibule or the facial nerve; the lateral portion of the internal auditory canal is not always seen. The fundus can be seen in only 50% of bones without opening the labyrinth.

[Comparative studies of the palatal mucosa under physiologic conditions and with removable dentures. II. The regional differentiation of epithelial layers]. / Vergleichende Untersuchungen der Gaumenschleimhaut unter physiologischen Verhältnissen und bei abnehmbarem Zahnersatz Teil II: Regionale Differenzierung der Epithelschichten.

On the basis of the morphological evidences of 22 adults with own teeth and 18 denture wearers a significant reduction of the thickness and the number of layers of the stratum granulosum could be established under dentures.

[Comparative studies of the palatal mucosa under physiologic conditions and with removable dentures. I. Epithelial height and papillary bodies]. / Vergleichende Untersuchungen der Gaumenschleimhaut unter physiologischen Bedingungen und bei abnehmbarem Zahnersatz. Teil I: Epithelhöhe und Papillarkörper.

Epithelium changes caused by wearing of tissue-borne prosthesis were established on the basis of tissue specimens, taken away from the palate of 22 corpses with own teeth and 18 edentulous corpses with removable prosthesis. The epithelium height of the denture supporting area was reduced especially in the lateral and ventral cuts. The papillary body was significantly reduced.

[The problem of degradation and histocompatibility of bioactive ceramics in soft tissues. 2. Descriptive and morphometric evaluation of uncoated and coated bioactive ceramics]. / Untersuchungen zur Problematik der Degradation und der Histokompatibilität von bioaktiven Keramen im Weichgewebe. 2. Mitteilung: Deskriptive und morphometrische Beurteilung der Histokompatibilität unbeschichteter und beschichteter bioaktiver Kerame.

After a 180 day lasting period of observation a persistent chronical inflammation occurred in the implants surrounding tissue of rats implanted with simple sintered biovitroceramics, where as the same material, coated with dental ceramic did not result in a comparable tissue reaction. After application of these coated implants we obtained a significant diminished formation of the periimplant connective tissue capsule. Inactivation of surfaces, being into contact with soft tissue, mentioned above, could be an economical, easy handling method.

[A new method of coloring ground bone implants for light microscopy]. / Eine neue möglichkeit der färbung von implantat-knochen-schliffen zur lichtmikroskopischen untersuchung.

The material exploration for implants close in also histological study of bone-proofs after implantation in test animals. For light microscopical utilization of implant-bone-polishings was developed a new method of colouring what shows a better distinction between types of tissue around the implant and a time economizing of 3 h.

[Selected light microscopy and polarization optical studies of implant-bone interfaces]. / Ausgewählte durchlichtmikroskopische und polarisationsoptische Untersuchungen des Implantat-Knochen-Grenzbereiches.

Implant bone specimen of inert materials and of the material BVK Ap 40 mended histologically. The bone specimen were both decalcified and carried to the polish technique after plastics embedding. The experiments were carried out in miniature swines (type Mini-Lewe) and rabbits. Microscopical and polarisation optical investigations were carried out. A connective-tissue membrane was provable at the interface implant-bone in all cases with use of the biocompatible material titanium. With BVK Ap 40 was observed a direct compound with the bone.